Institut national de santé publique du Québec, Quebec City, Québec, Canada; Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, Quebec City, Québec, Canada.
Institut national de santé publique du Québec, Quebec City, Québec, Canada.
Can Assoc Radiol J. 2019 May;70(2):186-192. doi: 10.1016/j.carj.2018.10.007. Epub 2019 Mar 8.
To examine the relation between breast cancer location and screening mammogram sensitivity, and assess whether this association is modified by body mass index (BMI) or breast density.
This study is based on all interval cancers (n = 481) and a random sample of screen-detected cancers (n = 481) diagnosed in Quebec Breast Cancer Screening Program participants in 2007. Film-screening mammograms, diagnostic mammograms, and ultrasound reports (when available) were requested for these cases. The breast cancer was then localised in mediolateral oblique (MLO) and craniocaudal (CC) projections of the breast by 1 experienced radiologist. The association between cancer location and screening sensitivity was assessed by logistic regression. Adjusted sensitivity and sensitivity ratios were obtained by marginal standardisation.
A total of 369 screen-detected and 268 interval cancers could be localised in MLO and/or CC projections. The 2-year sensitivity reached 68%. Overall, sensitivity was not statistically associated with location of the cancer. However, sensitivity seems lower in MLO posterior inferior area for women with BMI ≥ 25 kg/m compared to sensitivity in central area for women with lower BMI (adjusted sensitivity ratio: 0.58, 95% confidence interval [CI]: 0.17-0.98). Lower sensitivity was also observed in subareolar areas for women with breast density ≥ 50% compared to the central areas for women with lower breast density (for MLO and CC projections, adjusted sensitivity ratio and 95% CI of, respectively, 0.54 [0.13-0.96] and 0.46 [0.01-0.93]).
Screening sensitivity seems lower in MLO posterior inferior area in women with higher BMI and in subareolar areas in women with higher breast density. When interpreting screening mammograms, radiologists need to pay special attention to these areas.
探讨乳腺癌部位与筛查钼靶灵敏度之间的关系，并评估这种相关性是否受体重指数（BMI）或乳腺密度的影响。
本研究基于 2007 年魁北克乳腺癌筛查计划参与者中所有间隔期癌症（n=481）和随机抽取的筛查检出癌症（n=481）。为这些病例请求了胶片筛查乳房 X 光照片、诊断性乳房 X 光照片和超声报告（如有）。然后，由 1 名经验丰富的放射科医生在乳房的内外斜位（MLO）和头尾位（CC）投影中对乳腺癌进行定位。通过逻辑回归评估癌症部位与筛查灵敏度之间的关系。通过边缘标准化获得调整后的灵敏度和灵敏度比。
共可对 MLO 和/或 CC 投影中的 369 例筛查检出癌和 268 例间隔期癌进行定位。2 年的灵敏度达到 68%。总体而言，癌症部位与灵敏度之间没有统计学关联。然而，对于 BMI≥25kg/m2的女性，MLO 后下方区域的灵敏度似乎低于中央区域（调整后的灵敏度比：0.58，95%置信区间[CI]：0.17-0.98）。对于乳腺密度≥50%的女性，MLO 和 CC 投影的灵敏度在乳晕下区域也较低，而乳腺密度较低的女性的中央区域的灵敏度较高（分别为 0.54[0.13-0.96]和 0.46[0.01-0.93]）。
BMI 较高的女性的 MLO 后下方区域和乳腺密度较高的女性的乳晕下区域的筛查灵敏度似乎较低。在解释筛查乳房 X 光照片时，放射科医生需要特别注意这些区域。
